CHARLIE BROWN – 23565
Safe - 4-2-2018 Manhattan
SAFE 4/2/18 CHARLIE BROWN is a 4 yr old boy who is congested and has a URI, conjunctivitis and may have other issues. He needs a home asap where he can recuperate. Charlie Brown is friendly but just a bit nervous in shelter.
MANAHATTAN CENTER
Charlie Brown 23565
Location: Manhattan
Intake Date: 3/23/18
Intake Type: Stray
Medical Behavior: Green
Sex: Male
Age: 4 years
Original Location: 10452
DVM Intake Exam
Estimated age: 4yr
Microchip noted on Intake? neg
Microchip Number (If Applicable):
History : stray
Subjective: Q-BAR. A bit nervous, but calm, quiet, and friendly. Very well behaved during PE.
Observed Behavior –
Evidence of Cruelty seen – n
Evidence of Trauma seen – n
Objective
T =
P = wnl
R = wnl
BCS 5/9
EENT: OU blepharospasm, conjunctivitis, yellow mucoid discharge OD>OS. OD shut closed, upper and lower lid swollen. Ears clean, no nasal discharge noted. Scratches on nose.
Oral Exam: mild staining and gingivitis
PLN: No enlargements noted
H/L: NSR, NMA, CRT < 2, Lungs clear, mild congestion
ABD: mildly tense but non painful, no masses palpated
U/G: MI
MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat
CNS: Mentation appropriate – no signs of neurologic abnormalities
Rectal: normal externally
Assessment:
conjunctivitis
mild congestion
suspect URI with secondary bacterial infection
Prognosis: good
Plan:
move to ISO
erythromycin OU BID x 7 days
doxcycline 1mL PO SID x 10 days
vet check day 5 and 10
SURGERY:
Temporary waiver due to illness
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View all entries in: Safe Cats 2018-04